Research Article
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Ele gelmeyen testiste laparoskopi deneyimimiz

Year 2022, Volume: 6 Issue: 2, 138 - 144, 20.08.2022
https://doi.org/10.30565/medalanya.1061628

Abstract

Amaç: Çocuklarda ele gelmeyen testisler için yaptığımız laparokopik inmemiş testis amaliyatlarının tanı ve tedavide üstünlüğünü ortaya koymak.

Yöntemler: Kliniğimizde Ocak 2010 ile Eylül 2021 tarihleri arasında ele gelmeyen testis nedeniyle laparoskopik inmemiş testis araştırması yapılan 6 ay-18 yaş altı hastaların dosyaları retrospektif olarak incelendi. Genel anestezi altında yapılan muayenede palpe edilen testisler ve cinsiyet gelişim bozukluğu bulunan hastalar çalışma dışında tutuldu.

Bulgular: Çalışmaya 53 hasta dahil edildi. Hastaların ortalama yaşı 3,2 yaştır (min:8 ay-max 17 yaş). Hastaların %54,7’sinde (n=29) sol, %34’ünde (n=18) sağ ve %11,3’ünde (n=6) bilateral olmak üzere toplam 59 ele gelmeyen testis için tanı ve tedavi amacıyla laparoskopik girişim yapılmıştır. 59 testis için yapılan laparoskopide 31 tane testisin kord ve damarlarının inguinal kanala girdiği, 7 hastada karın içindeki testisin atrofik olduğu, 7 hastada kord ve damarların intraabdominal olarak kör sonlandığı (vanishing testis), 14 adet testisin karın içinde normal boyutta olduğu saptandı.

Sonuç: Ele gelmeyen testisler için yapılan laparoskopik eksplorasyonda atrofik testis bulunması durumunda eş zamanlı laparoskopik orşiektomi yapılmakta, özellikle inguinal kanala 2 cm’den uzak testisler için damarların bağlanmasına olanak vermekte, 2 cm’den yakın olan testisler için ise daha iyi bir görüş altında damarlarının serbestlenmesine izin vererek açık cerrahi komplikasyonlarından korumaktadır. 

References

  • 1. Wenzler DL, Bloom DA, Park JM. What is the rate of spontaneous testicular descent in infants with cryptorchidism? J Urol. 2004;171(2Pt1):849-51. doi: 10.1097/01.ju.0000106100.21225.d7.
  • 2. Kollin C, Granholm T, Nordenskjöld A, Ritzén EM. Growth of spontaneously descended and surgically treated testes during early childhood. Pediatrics. 2013;131(4):e1174-80. doi: 10.1542/peds.2012-2902.
  • 3. Al Hindi S, Khalaf Z. The outcome of laparoscopic assisted orchidopexy in very young children: A single hospital experience. J Pediatr Urol. 2021;17(4):536.e1-536.e7. doi: 10.1016/j.jpurol.2021.03.004.
  • 4. Başaklar C. İnmemiş Testis. In: Başaklar C, editor. Bebek ve Çocukların Cerrahi ve Ürolojik Hastalıkları. Vol. 2. Ankara: Palme Yayıncılık; 2006. pp. 1717–52.
  • 5. Cisek LJ, Peters CA, Atala A, Bauer SB, Diamond DA, Retik AB. Current findings in diagnostic laparoscopic evaluation of the nonpalpable testis. J Urol. 1998;160(3 Pt 2):1145-9; discussion 1150. PMID: 9719296.
  • 6. European Association of Urology. https://uroweb.org/wp-content/uploads/EAU-Guidelines-on-Paediatric-Urology-2019.pdf. Erişim: 29 Kasım 2021.
  • 7. Docampo MJ, Hadziselimovic F. Molecular Pathology of Cryptorchidism-Induced Infertility. Sex Dev. 2015;9(5):269-78. doi: 10.1159/000442059.
  • 8. Iqbal N, Hasan A, Saghir S, Iqbal S, Saif UB, Choudhry AM et al. Laparoscopic Orchiopexy For Management Of Bilateral Non-Palpable Testes. J Ayub Med Coll Abbottabad. 2020;32(4):445-449. PMID: 33225641.
  • 9. Erdoğan C, Bahadır B, Taşkınlar H, Naycı A. Laparoscopic management and its outcomes in cases with nonpalpable testis. Turk J Urol. 2017;43(2):196-201. doi: 10.5152/tud.2017.63625.
  • 10. Cortesi N, Ferrari P, Zambarda E, Manenti A, Baldini A, Morano FP. Diagnosis of bilateral abdominal cryptorchidism by laparoscopy. Endoscopy. 1976;8(1):33-4. doi: 10.1055/s-0028-1098372.
  • 11. Tennenbaum SY, Lerner SE, McAleer IM, Packer MG, Scherz HC, Kaplan GW. Preoperative laparoscopic localization of the nonpalpable testis: a critical analysis of a 10-year experience. J Urol. 1994;151(3):732-4. doi: 10.1016/s0022-5347(17)35074-7.
  • 12. Castilho LN. Laparoscopy for the nonpalpable testis: how to interpret the endoscopic findings. J Urol. 1990;144(5):1215-8. doi: 10.1016/s0022-5347(17)39697-0.
  • 13. Topuzlu Tekant G, Emir H, Eroğlu E, Akman M, Büyükünal C, Danişmend N, et al. Experience with laparoscopy in nonpalpable testis. Eur J Pediatr Surg. 2001;11(3):177-81. doi: 10.1055/s-2001-15494.
  • 14. Banieghbal B, Davies M. Laparoscopic evaluation of testicular mobility as a guide to management of intra-abdominal testes. World J Urol. 2003;20(6):343-5. doi: 10.1007/s00345-002-0304-1.
  • 15. Akova F. Laparoscopy in non-palpable testis: Single surgeon experience. Çoc. Cer. Derg. 2020;34(2):58 – 64. doi: 10.5222/JTAPS.2020.65042.
  • 16. Elderwy AA, Kurkar A, Abdel-Kader MS, Abolyosr A, Al-Hazmi H, Neel KF, et al. Laparoscopic versus open orchiopexy in the management of peeping testis: a multi-institutional prospective randomized study. J Pediatr Urol. 2014;10(4):605-9. doi: 10.1016/j.jpurol.2014.06.006.
  • 17. Kilic SS, Ozden O, Colak ST, Tutus K, Alkan M, Tuncer R. Clinical outcomes of laparoscopic treatment of non-palpable testis in children at a tertiary pediatric surgery center. Acta Med Alanya 2021;5(3):294-300 doi:10.30565/medalanya.959384.
  • 18. Dar SA, Bali RS, Zahoor Y, Rashid Kema A, Bhardwaj R. Undescended Testes and Laparoscopy: Experience from the Developing World. Adv Urol. 2018;24;2018:1620470. doi: 10.1155/2018/1620470.
  • 19. Demir M, Yağmur İ, Katı B, Pelit ES, Dusak A, Çiftçi H. Diagnostic Laparoscopy in Nonpalpable Testes; Single Center Clinical Results. Journal of Harran University Medical Faculty. 2020;17(1):1-5. doi:10.35440/hutfd.645863.

Our experiences of laparoscopy in the non-palpable testes

Year 2022, Volume: 6 Issue: 2, 138 - 144, 20.08.2022
https://doi.org/10.30565/medalanya.1061628

Abstract

Aim: To demonstrate the superiority of laparoscopic undescended testicular surgery for non-palpable testicles in children in diagnosis and treatment.

Methods: The files of patients between the age of 6 months and 18 years who underwent laparoscopic undescended testis investigation due to non-palpable testis in our clinic, between January 2010 and September 2021, were reviewed retrospectively. Patients with palpable testicles and patients with disorders of sex development in the examination performed under general anaesthesia were excluded from the study.

Results: Fifty-three patients were included in the study. The mean age of the patients is 3.2 years (min: 8 months-max 17 years). Laparoscopic intervention was performed for a total of 59 non-palpable testicles which were left-sided in 54.7% (n=29) of the patients, right-sided in 34% (n=18), and bilateral in 11.3% (n=6). Throughout these 59 testicles, cords and vessels of 31 testicles were visualized entering the inguinal canal, atrophic testes in the abdomen were detected in 7 patients, the cord and vessels had an intraabdominal blind ending (vanishing testis) in 7 patients, and 14 testicles were in the abdomen with normal aspect.

Conclusion: Simultaneous laparoscopic orchiectomy is performed in case of atrophic testis in laparoscopic exploration for non-palpable testicles. It allows the ligation of vessels of testes farther than 2 cm away from the inguinal canal, and for testes that are closer than 2 cm it grants the vessels to be released under a more precise vision thereby protecting from the complications of conventional surgery.

References

  • 1. Wenzler DL, Bloom DA, Park JM. What is the rate of spontaneous testicular descent in infants with cryptorchidism? J Urol. 2004;171(2Pt1):849-51. doi: 10.1097/01.ju.0000106100.21225.d7.
  • 2. Kollin C, Granholm T, Nordenskjöld A, Ritzén EM. Growth of spontaneously descended and surgically treated testes during early childhood. Pediatrics. 2013;131(4):e1174-80. doi: 10.1542/peds.2012-2902.
  • 3. Al Hindi S, Khalaf Z. The outcome of laparoscopic assisted orchidopexy in very young children: A single hospital experience. J Pediatr Urol. 2021;17(4):536.e1-536.e7. doi: 10.1016/j.jpurol.2021.03.004.
  • 4. Başaklar C. İnmemiş Testis. In: Başaklar C, editor. Bebek ve Çocukların Cerrahi ve Ürolojik Hastalıkları. Vol. 2. Ankara: Palme Yayıncılık; 2006. pp. 1717–52.
  • 5. Cisek LJ, Peters CA, Atala A, Bauer SB, Diamond DA, Retik AB. Current findings in diagnostic laparoscopic evaluation of the nonpalpable testis. J Urol. 1998;160(3 Pt 2):1145-9; discussion 1150. PMID: 9719296.
  • 6. European Association of Urology. https://uroweb.org/wp-content/uploads/EAU-Guidelines-on-Paediatric-Urology-2019.pdf. Erişim: 29 Kasım 2021.
  • 7. Docampo MJ, Hadziselimovic F. Molecular Pathology of Cryptorchidism-Induced Infertility. Sex Dev. 2015;9(5):269-78. doi: 10.1159/000442059.
  • 8. Iqbal N, Hasan A, Saghir S, Iqbal S, Saif UB, Choudhry AM et al. Laparoscopic Orchiopexy For Management Of Bilateral Non-Palpable Testes. J Ayub Med Coll Abbottabad. 2020;32(4):445-449. PMID: 33225641.
  • 9. Erdoğan C, Bahadır B, Taşkınlar H, Naycı A. Laparoscopic management and its outcomes in cases with nonpalpable testis. Turk J Urol. 2017;43(2):196-201. doi: 10.5152/tud.2017.63625.
  • 10. Cortesi N, Ferrari P, Zambarda E, Manenti A, Baldini A, Morano FP. Diagnosis of bilateral abdominal cryptorchidism by laparoscopy. Endoscopy. 1976;8(1):33-4. doi: 10.1055/s-0028-1098372.
  • 11. Tennenbaum SY, Lerner SE, McAleer IM, Packer MG, Scherz HC, Kaplan GW. Preoperative laparoscopic localization of the nonpalpable testis: a critical analysis of a 10-year experience. J Urol. 1994;151(3):732-4. doi: 10.1016/s0022-5347(17)35074-7.
  • 12. Castilho LN. Laparoscopy for the nonpalpable testis: how to interpret the endoscopic findings. J Urol. 1990;144(5):1215-8. doi: 10.1016/s0022-5347(17)39697-0.
  • 13. Topuzlu Tekant G, Emir H, Eroğlu E, Akman M, Büyükünal C, Danişmend N, et al. Experience with laparoscopy in nonpalpable testis. Eur J Pediatr Surg. 2001;11(3):177-81. doi: 10.1055/s-2001-15494.
  • 14. Banieghbal B, Davies M. Laparoscopic evaluation of testicular mobility as a guide to management of intra-abdominal testes. World J Urol. 2003;20(6):343-5. doi: 10.1007/s00345-002-0304-1.
  • 15. Akova F. Laparoscopy in non-palpable testis: Single surgeon experience. Çoc. Cer. Derg. 2020;34(2):58 – 64. doi: 10.5222/JTAPS.2020.65042.
  • 16. Elderwy AA, Kurkar A, Abdel-Kader MS, Abolyosr A, Al-Hazmi H, Neel KF, et al. Laparoscopic versus open orchiopexy in the management of peeping testis: a multi-institutional prospective randomized study. J Pediatr Urol. 2014;10(4):605-9. doi: 10.1016/j.jpurol.2014.06.006.
  • 17. Kilic SS, Ozden O, Colak ST, Tutus K, Alkan M, Tuncer R. Clinical outcomes of laparoscopic treatment of non-palpable testis in children at a tertiary pediatric surgery center. Acta Med Alanya 2021;5(3):294-300 doi:10.30565/medalanya.959384.
  • 18. Dar SA, Bali RS, Zahoor Y, Rashid Kema A, Bhardwaj R. Undescended Testes and Laparoscopy: Experience from the Developing World. Adv Urol. 2018;24;2018:1620470. doi: 10.1155/2018/1620470.
  • 19. Demir M, Yağmur İ, Katı B, Pelit ES, Dusak A, Çiftçi H. Diagnostic Laparoscopy in Nonpalpable Testes; Single Center Clinical Results. Journal of Harran University Medical Faculty. 2020;17(1):1-5. doi:10.35440/hutfd.645863.
There are 19 citations in total.

Details

Primary Language English
Subjects Surgery
Journal Section Research Article
Authors

Osman Hakan Kocaman 0000-0002-8072-5292

Tansel Günendi 0000-0001-5356-1061

Early Pub Date August 20, 2022
Publication Date August 20, 2022
Submission Date January 22, 2022
Acceptance Date July 1, 2022
Published in Issue Year 2022 Volume: 6 Issue: 2

Cite

Vancouver Kocaman OH, Günendi T. Our experiences of laparoscopy in the non-palpable testes. Acta Med. Alanya. 2022;6(2):138-44.

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